a blog of books every doctor should read

Willpower

Synopsis

The key messages of this book are that success in life is determined by the ability to exert self-control, and lack of willpower lies at the root of most personal and social problems (page 2). The authors review the influence of willpower on our thoughts, emotions, impulses, and performance (pages 36-37), and they discuss the day-to-day activities that threaten willpower such as eating, sleeping, leisure, sex, and networking (page 3). They review the reasons why strategies to resist temptation, such as distraction and suppression, frequently fail, and they argue that willpower is best applied to avoiding, rather than overcoming, temptations (pages 3 and 239). The authors support their arguments with research findings such as the Stanford marshmallow experiment, synonymous with WalterMischel, which shows that children with the capacity for delayed gratification grow up to be successful and healthy adults (pages 10-12).

The authors define willpower as a finite and fatiguable resource which, just like a muscle, may be strengthened through exercise, or depleted by its exertion, a state they call ego depletion (pages 25-28). The factors which deplete willpower are varied and include stress, chronic pain, sleep deprivation, and impassioned states (pages 33, 36, 59, and 106). The book says the willpower-depleted state manifests as physical fatigue, strong cravings, heightened reactions, and negative emotions such as irritability, anger, despair, excessive sleep, and impulsive spending (pages 30-33). The book explores many other significant effects of depleted willpower such as error-proneness, inflexibility, impaired judgment, a heightened state of loss aversion, and a reluctance to give up options (pages 99 and 245-247). The authors review the research findings which show that glucose helps to replenish depleted willpower, and they support this assertion with evidence linking low glucose levels with criminal and violent behaviour (pages 44-45).

At the core of willpower is the self-regulating personality, and the book reviews the factors that contribute to its development. The authors particularly focussed on parenting styles and teaching methods, with the illustrative example of the Asian child raising style popularised by Amy Chua in her book TheBattle Hymn of the Tiger Mother. These methods focus on goal setting, rule enforcement, punishment of failure, and rewarding excellence (pages 187-213). In contrast, the authors argue, the western culture of building self-esteem leads to low self-control, narcissism, a sense of entitlement, poor school and work performance, and inability to delay gratification (pages 192-195). The book reviews other key factors that encourage willpower and enhance self-control such as religious practices and having lofty ideals (pages 165 and180-181).

The authors makes many recommendations on improving self-control. They say, for example, that ‘the first step in self-control is to set a goal‘ (page 16). They particularly recommend the application of self-control ‘to establish good habits and break bad ones’ (page 157). Other recommendations include focusing on one project at a time (page 38), adopting monthly rather than daily plans (page 72), and using pre-commitment to avoid straying into the path of temptation (page 151). They also advocate self-awareness, monitoring of behaviour, and adopting upright postures (pages 113-132). The book cautions against relying on willpower to avoid temptation because self-control often fails in the impassioned state (page 255). The book reassuringly asserts that ‘exercising self-control in one area seemed to improve all areas of life’ (page 136).

The authors use many illustrative stories to support their arguments. An example is the indulgence of Mardi Gras (Fat Tuesday), the day before the commencement of Lent, when ‘losing self-control becomes a virtue’ (page 41). Another story is Benjamin Franklin’s unsuccessful attempts to keep to his 12 virtues (page 63). They also related Oprah Winfrey‘s repeated failure to maintain weight loss after dieting, something they labelled as the Oprah Paradox or the ‘what-the-hell effect’ of dieting, a result of counter-regulatory eating (pages 214-237). The book also referred to AlcoholicsAnonymous, the organisation that keeps its members teetotal by using standard setting, self-monitoring, and social support (pages 173-177). Other stories, which however seemed unnecessarily overdrawn, relate to David Blaine and the travails of HenryMorton Stanley in Africa.

Opinion

The book makes the excellent case that willpower underlies success. The lead author’s involvement in the key research underpinning the science shines through. The book is refreshingly well-written and sticks to the subject throughout, a feat of self-control many authors struggle to attain! My main criticism is the tendency for the text to repeatedly, and irritatingly, refer to the first author in the third person, often in a fawning manner. The latter sections of the book were also rather speculative and not based on much evidence. Some of the book’s assertions are contentious, such as the link between glucose levels and willpower depletion. These minor points aside, the book’s arguments are clear and rather well-made.

Overall assessment

This is a key piece of work, addressing a fundamental issue that covers all aspects of life. Understanding the nature of self-control, and its clear association with achievement, should influence all cadres of the medical profession. It is difficult to overstate the significance of the topic, and I recommend this book to all doctors.